Please help us welcome Dr. Vanessa Cullins into the EMandLO.com fold. She is a board-certified obstetrician/ gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America who will be answering your questions here every few weeks. To ask her your own question, click here.
Dear Dr. Vanessa,
My husband and I are late 30s/early 40s, with two great kids. We don't want any more, so we're trying to decide between tubal ligation and a vasectomy. My vote is for the vasectomy - I carried and delivered the kids, so now it's his turn. Plus, tubal ligation is much more invasive and painful and expensive, from what I've heard. Seems like a no-brainer to me, but he's wary of getting snipped. What do you think?
Deciding who will get sterilized can be a difficult decision requiring serious soul-searching conversations over time. You are right about vasectomy. It's less expensive, complications are extremely rare, and as surgeries go, it is less invasive than tubal sterilization. I think it is very important that you and your husband continue to talk about what a decision about vasectomy means to you and what it means to him.
It is important that you find out more about his reluctance to have a vasectomy. He may fear that vasectomy will affect his ability to have or maintain an erection. Or he may have experienced a time in his past when he experienced scrotal pain that he does not want to run the risk of experiencing again as he recovers from the procedure. Or he just might not like doctors or going to the doctor or having an operation, no matter what the operation is. Neither you nor I can guess what is fueling his reluctance.
In the same vein, he may not really realize just how important it is to you that he now take responsibility for preventing pregnancy. These private conversations may take weeks to months to work through. You may even need to consult with a urologist who is experienced in vasectomy and a counselor, so that they can help your husband become more comfortable with how the procedure is done and what recovery is like. One thing is for sure, neither you nor he should make a decision that leads to lasting resentment and marital discord.
He may come to recognize that his sexual experience will not change after vasectomy - that even his ejaculate will look the same and appear in about the same amounts. This is because most of the fluid in ejaculate is seminal fluid and fluid from the prostate and Cowper's glands. Flow of this fluid is not interrupted by vasectomy. Vasectomy just prevents sperm from being in the fluid. Sperm make up only two to five percent of the ejaculate, and that's too small an amount to be notice.
Some men have a deep cultural and emotional fear of castration - that their bodies will stop producing testosterone, the hormone that makes a person masculine. Vasectomy is not castration. The hormones that affect masculinity, including beard growth, voice, sex drive, and muscle tone, will still be produced in the testicles and released into the blood where they will still flow throughout his body and do their jobs.
Check out the Planned Parenthood for more information about vasectomy.
Whether you continue to have your discussion about sterilization with one another only or with a urologist or a counselor, it's very important to understand one another's point of view. So be sure that both of you listen carefully and kindly to one another about concerns each of you has. The decision should not be a contest of who has the strongest will. Hopefully the process of coming to a decision that feels right to both of you will bring both of you much closer to each other.
Best of luck as you both figure out what is best for your family, and your marriage.
--Dr. Vanessa Planned Parenthood
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Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.
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